Tuesday, December 04, 2007

Romania's Demography At A Glance

"...the fetus is the socialist property of the whole society. Giving birth is a patriotic duty, determining the fate of our whole country. Those who refuse to give birth are deserters."

Nicolae Ceausescu addressing a Communist Party congress in 1986

Well for those of our readers who thought I had said all that could be said about Romanian demography in this monster post here, I have a rather nasty surprise: there is more. Scratching my head about the spike I found in the Romanian natality and mortality data I started scratching around a little more, and what follows is what I came up with.

And before I go any further, here's one for your bookmarks, since browsing around for information on Romananian remittances I came across the very intersting "Romanian Migration to Spain - Motivation, Networks and Strategies" by Ana Bleahu, from which I have drawn the above reasonably graphic chart. Bleahu's article is a working paper (careful PDF) from the Institute for Quality of Life at the Romanian Academy, Bucharest. Despite some evident shortcomings, the document is a mine of information, and very readable for the insight the interviews it is based on offer as to the actual motivations of the out-migrants.

As the above diagram makes clear, Romanians are leaving, and in large numbers. The charts I present in this post here - based on data from Italy's ISTAT and Spain's INE - indicated that at this point there are at least a million Romanians (out of a total population of around 20 million) living and working in Spain and Italy alone. Whether this migration is temporary or permanent remains to be seen, and the answer depends in large part, I would suggest, on what happens next in Romania.

Too Much Money Chasing Too Few People?

Now one of the big arguments Claus and I are pushing at the moment - on this blog and elsewhere - is that the sudden acceleration in inflation which we are now witnessing across a whole swathe of emerging economies in Eastern and Central Europe is not simply accidental, or coincidental. Nor is it a simple by-product of collective poor institutional quality, bad government and/or endemic corruption. There are larger, and in historical terms grander, "big picture" processes at work here.

One of these processes is intimately related to the very specific and unusual demographic profile which most of Eastern Europe has inherited from its recent past. So one of my central arguments is that what we have here is a kind of mis-match. A mis-match between a basically third world. "developing-country" type, income level (for this reason they tend to be called "emerging economies") and a very-first-world-type age structure - in the sense that many of these societies have had below replacement fertility for several decades now, and that the key 25 to 49 age group is now peaking nearly everywhere as a proportion of the total population.

But even their demography is pretty unique, since you could say that many Eastern European societies have a mature society population age structure, but with the top of the pyramid effectively lopped off. Lopped-off in the sense that life expectancy - and especially male life expectancy - is normally considerably lower than it is in Western Europe, or other developed economies like Japan. The implications of this are - at this point in time - far from clear, what we have effectively is a research "work in process" in hand here, since we will only know what the implications are as and when we get to see them. In this sense Eastern Europe has become a living laboratory.

But one thing is becoming increasingly clear, and that is that this underlying life expectancy reality is making the raising of participation rates among the over 60 population - which is basically the Lisbon Process "remedy" for addressing the problem of declining working age populations and rising elderly dependency ratios - a far more difficult result to envisage. Rather than increased participation rates, what we are getting as the labour market tightens is accelerating inflation, and this would now seem to constitute some sort of empirical fact.

My argument then (roughly summarised) is that the current epidemic of dramatic "overheating" which is extending itself across the map (and to non-EU destinations like Russia or Ukraine as well) is a by-product of this very special and almost unique combination of demography and poverty (I say almost since you can find this sort of mix elsewhere, for example in the Southern Indian state of Kerala).

Combined and carefully shaken these two ingredients have produced the rather unstable cocktail mixture of a substantial out migration of workers in search of a better standard of life (the poverty effect) together with a shortage of young new labour market entrants (the demographic/low fertility) effect. The twin pincer consequence we have here seems to be a very combustible mixture as we are seeing.

As I say, part of all this is driven by a very structurally distorted underlying demography. As they say demography casts a long shadow, and just how long is very well illustrated by the long run impact of Ceausescu's crazed version of pro-natalism introduced in the late 1960s. The consequences of this policy are very much with us today in the form of Romania's very unusual age structure pyramid (see below). In the pretty unique world of Eastern European demography, Romania stands out as being even more unique.

Demography at a Glance

So, and without more ado, let's now take a rather closer look at this Romanian demography, and to get the ball nicely rolling why don't we start by taking a quick glance at Romanian fertility.

Despite the fact that we have a gap in the data during the late 1980s a number of things stand out clearly enough in the above chart. The first of these is that fertility in Romania was already making the transition to below replacement level by the early 1960s, and in fact dropped below replacement level in 1962. The second is that fertility suddenly shot up in 1967. This was the year the infamous Ceausescu pro-natality campaign was introduced (and you can read more about all this in this post here, but since all of this is such an important aspect of Romanian history, and since the historical memory of Romanian society seems to have a major lacuna here, I am taking the liberty of reproducing a short extract from this book (Ronald D. Bachman, ed. Romania: A Country Study. Washington: GPO for the Library of Congress, 1989. More References at the foot of the article) which gives some essential background.

With a political system in place that made long-range planning the cornerstone of economic growth, demographic trends took on particular significance. As development proceeded, so did disturbing demographic consequences. It soon became apparent that the country was approaching zero population growth, which carried alarming implications for future labor supplies for further industrialization. The government responded in 1966 with a decree that prohibited abortion on demand and introduced other pronatalist policies to increase birthrates. The decree stipulated that abortion would be allowed only when pregnancy endangered the life of a woman or was the result of rape or incest, or if the child was likely to have a congenital disease or deformity. Also an abortion could be performed if the woman was over forty-five years of age or had given birth to at least four children who remained under her care. Any abortion performed for any other reason became a criminal offense, and the penal code was revised to provide penalties for those who sought or performed illegal abortions.

Because contraceptives were not manufactured in Romania, and all legal importation of them had stopped, the sudden unavailability of abortion made birth control extremely difficult. Sex had traditionally been a taboo subject, and sex education, even in the 1980s, was practically nonexistent. Consequently the pronatalist policies had an immediate impact, with the number of live births rising from 273,687 in 1966 to 527,764 in 1967--an increase of 92.8 percent. Legal abortions fell just as dramatically with only 52,000 performed in 1967 as compared to more than 1 million in 1965. This success was due in part to the presence of police in hospitals to ensure that no illegal abortions would be performed. But the policy's initial success was marred by rising maternal and infant mortality rates closely associated with the restrictions on abortion.

The above described episode has had a clear, evident and lasting impact on the age structure of the Romanian population, and we can readily see this if we take a look at a breakdown of the 2006 population by age, since we can see an evident spike in the 37-39 age range.

Now if we come to think about the actual drivers of fertility, it would be really interesting to know why Romanian fertility was hitting such low levels during the early 1960s. As far as the drivers of low fertility go in the short term, the key indicator is normally the rate of birth postponement. Birth postponement is a process which normally revolves around the rising age at giving first birth of those women who decide to have children. It is thus a timing decision, and normally reflects growing investment of young women in their own education or career oportunities. In the Romanian case we do not have specific data for this age, but (again thanks to Eurostat) we do have data for mean age on childbirth, and since most Romanian mothers now have only one child this is not a bad indicator, since the number will be lower, but not that much lower (possibly between 1 and 2 years).

As we can see, the median age at childbirth has been rising slowly but steadily from the mid 1990s, and this process is, in part, behind the very low fertility readings which have been registered in Romania in recent years. But if we think about the current level which is still under 27 (and this is an average for ALL births and not just first births, so the first birth median age might be what, 25.5?) then this still significantly below the Western European norm, which is around the 30 mark. So more years of very low fertility are to be anticipated as postponement continues, and if Romania hits a major economic crisis in the meantime (which is, I am afraid, a very distinct possibility) then we may get stuck in exactly the kind of low fertility trap which the Austrian demographer Wolfgang Lutz has so ably identified.

What we don't know at this point though (since I have been unable to find any data on this interesting topic) is what the first birth age of women was in Romania in the late 1950s/early 1960s. Given the relative poverty and economic backwardness of the country at the time a modern postponement process would seem to be an unlikely candidate for the very low fertility which was being registered, and pressure to work combined with a very "free and easy" abortion system would seem to be a more promising candidate explanation.

However moving on now to the natural evolution of the Romanian population, I think it is worth taking a look at the live births' chart:

Apart from the obvious spike in births in the late 60s which we have already spoken about, it is also worth thinking about the sharp drop in the number of births which took place around the end of the 1980s. To put this in some perspective we might point out that in 1988 some 380,000 children were born, while in 1991 this number was down to 275,000. This is a drop of over 100,000 children a year in just 3 years (and of course the annual rate has subsequently only dropped further). So in 2009 there will be 100,000 young people of 18 years of age LESS than might otherwise have been the case, and the Romanian labour market is BOUND to notice this sharp adjustment, out-migration or no out-migration.

Also, if we come to look at the balance of births and deaths, we will again observe some strange details in the data, including the abrupt rise in the number of registered deaths after 1967, but also the fact that the natural rate of population increase, that is births minus deaths (ignoring migration effects) turned negative in 1991.

So if we look at the theoretical population position we will see this negative growth confirmed:

Turning to life expectancy at birth, we will see, despite a decline in the early 1990s (which may have been associated with high infant mortality) the headline number is now rising, but it is still low in comparison with Western Europe, and this is going to have important economic implications, not least because it places severe limitations on one of the favourite economic recipes for getting out of the kind of problems Romania is getting into, namely raising participation rates in the over 55 age group. Looking at all this data it may well be that the health of the older Romanian population is just not up to taking this kind of strain. I suspect we are going to hear a lot more of this kind of issue in the East European context in the months and years to come.

Finally, to complete our demographic round up, we could look at the median age of the Romanian population. This age is - at a current level of 36.9 - very young by modern standards, but it is hard to know what interpretation to put on this, since Romania is hardly a "young" population in the sense that Iceland or Ireland are, since the whole structural configuration of the demographic panorama is so uniquely skewed and distorted, and in part the comparatively young median age is a reflection of the comparatively low level of life expectancy.

Now what stands out here is just how comparatively young Romanian society is at this point. This could become clearer if we put Romanian median age up against Slovenian median age, since Slovenia is effectively the youngest member of the EU10 (although still significantly younger than the older West European societies like Germany or Italy).

Really at this point I am neither sure how to interpret this, nor of the significance of this difference in ages between these two societies. Normally this more youthful effect would be associated with a much later decline in fertility to below replacement (say Ireland or Iceland), but this is not the Romanian case and it undoubtedly has something to do with the specific weight of the ceaucescu cohorts within the population, but quite what this will mean I am not really sure at this point. I don't imagine anyone is, since we have never really been here before.

Again, this key age group exhibits strange behaviour in the Romanian case, since (despite the inevitable gaps in the data) we can see that this group is already dropping as a share of the population in the 1970s (which is most unusual) and then of course (after the "birth spurt") it starts to climb again, and now it seems to have peaked again. But it seems to have peaked at a very low share - 37 (while 38/39 would be more normal) and at a very low median age (36, while 40 would be much more usual, again, if only we knew how to interpret all this). And then you have the million or so people who are there (in the official numbers), but aren't (insofar as they are out of the country). How will they affect things? I wish I knew the answer to all of this, but one thing is sure, we will find out soon enough, although unfortunately by that time it may well be too late to do anything constructive.

Population Pyramids

Finally lets have a look at some population pyramids, which, in the Romanian case aren't any more re-assuring. I have chosen here to make a comparison with Ireland, since Ireland has had a more or less normal (if somewhat delayed) demographic transition, and has been fully able to leverage this to get the full blast of her "demographic dividend". If we look at the pyramids for the early 1990s we can see that this is when Romania in principle was best positioned to get the rapid catch up growth, and this is, of course, when Ireland was doing exactly that.

If we look at the transitions through the pyramids, we can see that Ireland's path is a lot more stable than Romania's, and especially when we bear in mind that Ireland has, since the end of the 1990s been a strong net receiver of inward migration, while Romania's has been exactly the opposite case.

But really the most striking contrast is in the 2020 pyramids, since we can see that while Ireland's population is ageing, and the elderly dependency rate is rising, this is happening much more slowly than it is in Romania, and the whole pyramid is a lot more stable and sustainable, the bottom section is a lot thinker if you will. As I say, I wish I new exactly how to interpret all this, but one thing is for sure, the difference between Ireland and Romania's demographic evolution is not in Romania's favour.

By Way of Conclusion

Well returning to our point of departure and the crazed policies of Nicolae Ceausescu, perhaps it isn't necessary to say this at this point (after all the posting it shouldn't be!), but those of us on this blog who are advocating pro-natalist policies to help offset the more dramatic effects of population ageing, normally think in terms of an approach which is more along the lines of the Swedish or French ones, and we would obviously wish to completely dissociate ourselves from the type of coercive pro-natalism which was advocated and implemented by the likes of Ceausescu and his ilk. What we are arguing for is a collective effort on the part of the whole of society (organized inevitably via the state) to transfer resources to those women who would like to have children (Adam Smiths "hidden hand" seems to have gone "missing" at just this point, in the sense that societies and economies do not seem able to guarantee their own reproduction, which is at the end of the day a necessary prerequisite for economic growth as we now know it, so this is precisely the kind of case the old founder of libertarian economics would have had in mind as a justification for state intervention). What is being advocated by modern pro natalists then is a policy to support choice, one based on the secure knowledge that our collective interest as societies lies in the direction of doing this, and of reproducing our populations (even if in decline) across a stable trajectory. Our future lies in this direction since otherwise.... well, unfortunately we are more than likely just about to find out what the otherwise alternative is in the present Romanian case.

Unfortunately, however, maybe at the end of the day Ceausescu was right about one thing, maybe the rate of childbirth does determine the whole future of a society, and for many decades to come. His authoritarian attempt at social engineering however has very definitely become part of the problem legacy, and not part of the solution.

Bibliography and Appendix

Extract from Estimating the Consequences of Unintended Fertility for Child Health and Education in Romania: An Analysis Using Twins Data, by Peter J Glick, Alessandra Marini and David E Sahn.

Among the hardships faced by Romania’s population under Ceausescu was an almost uniquely harsh population policy. When Ceausescu came to power in 1965, Romania’s birth rate (15.6 per 1,000 population) was 44% lower than in 1950, in large part due to an exceptionally liberal abortion policy (Baban and David, 1996). With the aim of reversing this downward trend in fertility, the government in October 1966 made family planning and abortion illegal with only rare exceptions.

As a consequence of this law as well as restrictions on access to modern contraception and a range of other pronatalist policies (including divorce restrictions as well as financial incentives to bear children), the birth rate tripled from 13 to 40 per 1,000 in less than one year (Streatfield, 2001). Additional and even harsher measures were enacted in 1985, including among other practices compulsory regular pregnancy tests of women in their twenties (David, 1990). Public health consequences of these policies were severe, including extremely high rates of maternal mortality as women resorted to unsafe illegal abortions (Baban and David, 1996) and the placement of large numbers of unwanted children in overcrowded orphanages.

With the 1989 revolution, policy reversed again: the pronatalist policies were revoked and abortion and contraception were legalized. The rate of legal abortion quickly reached the highest level in the world, with about 200 abortions per 100,000 women aged 15-44 in 1990 (Serbanescu et al, 1995). Access to modern contraceptives improved but they remained generally unavailable (RAPHHM 1999; Baban 1999) and contraceptives knowledge was poor, in large part due to misinformation spread by the Ceausescu regime. There were modest declines in infant mortality and larger reductions in maternal mortality (Serbanescu et al., 1995; Mureşan and Rotariu, 2000) but these ratios were still the highest in Europe a half decade after the revolution.

All women were forced to go for a gynaecological control every month, this monthly health control representing the requirement for receiving medical care8. The pregnancies detected were monitored until term. In this way, the possibilities to provoke an empirical abortion were almost totally annihilated. The law was extremely severe, numerous gynaecologists as well as women who resorted to this method paying with years of prison their trial to avoid it. At the same time the law punished the sale of modern contraceptive means which, as a result, disappeared from the specialised shops. All persons over 25 years old who did not have children (excepting those who had valid medical infertility problems) were punished for celibate, paying 30 per cent tax on income.

The generations 1967 and 1968 are the largest in Romanian history, the children born during this period being informally called “ceausei” (Ceausescu’s babies).

Consequences of the Decree no. 770/1966 concerning prohibition of abortion

However, on long run the consequences of applying this law were not at all favourable to Romania. Firstly, the rate of maternal mortality – and especially that of maternal mortality caused by abortion – reached in Romania the highest position in Europe. As it could be noticed into the table 2, in 1980 in Czechoslovakia this index was 9.2. This value is the lowest in comparison with Romania, were this index reached the level of 132.1. After almost 10 years, in 1989 it can be noticed that generally, the woman’s situation – at least from this point of view – knew a substantial improvement in this part of Europe, excepting Romania, which registered a substantial increasing of it (169.4), maintaining the top position.

Another consequence of this law was a high increasing of the infant mortality rate. Between 1967–1989 there were born almost 10 millions children. 340,000 of them died before reaching the age of 1 year. Demographers estimate that 20 per cent of children born in this period were under-weight or with congenital malformations, this fact affecting negatively the biological quality of population.

10 comments:

Anonymous
said...

Nice essay. I'd be interested to know what, exactly, are the best pro-natalist policies. I would suggest 5 years income-tax holiday per child. Four children equals 20years tax-free.

At present, the young subsidize the aged across the developing world. This is quite obviously "killing the goose" that lays the golden ovum. I don't have the stats, but I would wager that taxes are lower in the US, Ireland, and Iceland than elsewhere.

One additonal follow-up: the Democrats favor European-style tax structures and social benefits. In other words, they would raise taxes massively to pay for pensions and senior medical care. This would have the double deleterious effect of slowing growth and suppresing fertility to European levels, which all but guarantees a European-style collapse.

You might want to do a post on whether legalized abortion affects birth rates. In the short run, I would say "No," since there are countries with very stringent anti-abortion laws and very low birth rates (Poland jumps immediately to mind). But in the long run, it seems feasible that a culture that has not internalized a lifestyle of free and easy abortion would be better able to weather short-term economic crises from a demographic standpoint.

Also, there's the fact that repeat abortions can lead to chronic infertility.

Marc, I would love to investigate this whole thing further, but I have one problem: time. Economic events in Eastern Europe are moving very quickly at the moment, and arguably a large part of the inflation problem which faces them is a by-product of their demographic inheritance, so Claus and I are pretty focused (within reasonable limits) on this at the moment, which means we are neglecting many of the broader topics which truly belong on this blog.

I'm not sure whether it is abortion as such, or the general availability of some effective form of birth control that is the issue. US fertility went for a nose dive in the 1970s following the general availability of the pill. So the difference in Romania is that it was abortion and not the pill which became the predominant form of contraception. Now I don't want here to venture into the highly charged atmosphere of pro- or anti-abortion, but obviously abortion should never be used in this way, apart from any other reason for the very practical consequence you mention:

"Also, there's the fact that repeat abortions can lead to chronic infertility."

Generally I think repeated and mindless recourse to abortion as a routine form of birth control has to be extremely corrosive on the moral fabric of a nation.

Incidentally, since large numbers of Romanians started arriving in Spain the abortion numbers have shot up.

Even though abortion is reasonably freely available in Spain the majority of the native Spanish population only have recourse to it very occasionally. Those medics I know who work weekends in hospital casualty centres tell me that those young Spanish people who "forget" their condoms show up at hospitals in significant numbers looking for the morning after pill (this is one of the main duties on a Saturday night). Young Moroccan girls normally don't have pre-marital sex, while young Ecuadorian ones do so habitually and then have the child. The result is that adolescent pregnancy is again on the rise here, but almost exclusively "native Latin Americans" are involved: ie in all of this cultures do matter, and we do seem to have fat tail distributions, and lock-in.

Anonymous said:

"I'd be interested to know what, exactly, are the best pro-natalist policies."

Well me too. And again, while trying to understand this better is one of the objectives of this blog, please bear in mind the time constraint I plead to Marc above.

The difficulty is that - if we look at OECD countries - those who have done tolerably well in the fertility game - France, the US, Scandinavia, the UK, Ireland, Australia (that's about it I think) - all have very different characteristics, and different "regimes" for handling the fertility question.

The only clear characteristic that these countries seem to share is that they started their transition earlier, and hence it was a slower and more protracted affair. Almost exclusively those who come later (and with a more rapid rate of decline) keep on going down to lowest-low fertility (1.2/1.3 TFR range). This is an important result, and really suggests that we should be doing a lot more about what is happening in some of the newly emerging economies than simply investing our savings and buying their cheap products.

Gender equality is also an issue, but this could be correlated with the social transformation being slower than the economic one. However, if you look at Japan, it is clear that they have gotten right through to the other side of the transition (ie they are now old and rich) without making the shift, and now as their population ages very rapidly they seem to be becoming more and more socially conservative, so this could become self-reinforcing.

I will put a brief post up on the US situation later in the week, since I have been preparing some data, but the US is certainly the least challenged on this front of anyone I have looked at, nevertheless I agree wholeheardtedly with you that putting the burden of paying for population ageing on an ever diminishing proportion of young people has to be a very bad idea.

I am not getting drawn on the political side of things beyond that. Basically I am even surprising myself, since I find I am increasingly able to do passable macro-economic analysis without reference to politics (passable in the sense that there is a reasonably acceptable coincidence between what the analysis suggests will happen and what actually does). Conclusion: either I am doing something very, very wrong, or a lot of other people are.

I am in the upper income strata here in the US, and it seems clear to me that the TFR among these groups is considerably higher than among the middle-income ones. Yes, the mothers are generally much older, but we often see three-child families. The wealthiest demographic tranches have gotten richer over the past quarter century, and the fertility seems to have risen concomitantly.

I wonder if, as promised by Democrat politicians, the "wealthy" are subject to greater taxation they will also produce fewer children and so limit tax collections and growth a generation hence (the top 10% pay the overwhelming majority of taxes already).

I happen to be born in Romania in 1968. I also happen to have immigrated to US almost 10 years ago. I am a physician and I am starting to become interested on the issue, as we are pondering if we should return to Romania.

one possible explanation of the decrease in natality in romania after 1955 or so could be found in the drastic socio-economic changes brought by imposition of communism by the Red Army after 1945. Romania was a unique case in the area. While central european countries - Czechoslovakia, Hungary, East Germany had made prior to WW2 the transition to an industrial society, Romania was in 1945 a country were 85-90% of population was living mainly from subsistence agriculture. the communist guverments have embarked after 1948 on large scale industrialization. This meant a huge shift of rural population to cities. However this was done on a chaotic, albeit centrally commanded way. Most of the people 18 to 30 years of age left their villages for a job in a factory. the stimulus to leave your village was that after land expropriations and forced colectivization many young people had no good way of surviving in their village but to work for meager wages in the colective farms. the jobs in the factories offer better even though still bleak prospects.

This shift has created housing shortages in the cities and I believe some gender disequilibriums (in a town with a big steel or mechanical plant most of the jobs were for men). Most of the workers lived in communal dormitories or rented a room from a family that had a slightly larger house. While the contact between sexes was not diminished for very many couples there was no way they could afford a place to live and raise a family. Hence the abortion problem, given the fact that sexual education was non-existent and that the traditional agrarian society moral code was broken. A young woman living in a dormitory with 5-6 other women who became pregnant, had the abortion as the only option out of the situation. If she lived in rented room (very likely another young woman so they can afford the rent) the owners very likely would have refused to let her move with her partner/husband and raise a child in an already overcrowded house.

The housing shortages in the cities have gradually improved after 1965 and overall the economy was more favourable until early '80s. I believe the natality would have improved on its own in the '70s (as the living standards did improve), albeit not in the abrupt way the Ceausescu decree in 1966 had forced the things. My parents were in their early 20's in 1968 when they got married. my father who was an engineer was promised the assignment of a 1 bedroom apartament in early 1968. Both of them lived until that point in rented rooms. Should that not happen likely they would not have gotten married and I would not have existed to tell their story.

Despite the official abortion interdiction the problem persisted well into the 70's. This lead Ceausescu to reinforce the coercive policy in the 80's as the natality continued to slide.

I also think I might have an explanation for the decrease in life expectancy in late 80's and early 90's. In the late 80's the Romanian economy was in shambles. After being hit by the oil crisis of early 80's and having had contracted several billions $ of foreign debt plus the inefficiencies of a command economy. In mid 80's Ceausescu decided to pay the foreign debt. this was done in a unusual and mindless way. Imports were strictly controled and everything that could be exported was to be exported - mostly raw materials and agricultural products and very few manufactured goods that had enough quality and the government could find a market outside most of the time at discount prices that barely covered the production costs (if anybody knew at all what those costs were in the highly distorted economy). The debt was indeed payed by 1988. However this has meant the rationing of most food products - grains and bread, sugar, cooking oil, dairy products, meat but also gasoline/heating oil, electricity (scheduled black-outs were the norm in the winter in most Romanian cities). everything was scarce and commanded huge premiums on the black market that flourished.

part of the planned shortages were also those of medicines and medical supplies. barely any medical equipment was bought between 1985 and 1990. probably hundred of thousands of children were vaccinated without using single use needles. This explains why Romania had in 1990 more cases of HIV infection in children than in adults. there were no programs in place of addressing chronic diseases. hygiene in psychiatric hospitals ( sanitarium type where patients were chronically institutionalised) and orphanages was dismal. unfortunately, there was no shortage of tobacco and alcohol that remainde widely available and affordable. even though the rate of alcoholism was probably not as high as in USSR it was not a minor problem.

I have not tried to calculate what was the impact of the several thousands cases of AIDS in children diagnosed immediately after 1990 on the general life expectancy but surely, along with other causes of infant and childhood mortality, they were responsible for part of the decrease. Likely most of preventable deaths were from cardiovascular diseases, liver cirrhosis (related both with alcohol but also with hepatitis B infection that was endemic), COPD, cancers. Infectious diseases even though they were a lot more of a problem than in developed countries were not a major player overall as a cause of preventable mortality ( one exception was probably TB were Romania had in 1989 probably among the highest prevalence rates than any former communist country).

While the situation was not as dire as the current one in North Koreea probably no other European people ( except may be the Albanians) have endured so many socio-economic abuses from a communist regime after Stalin's death.

The 80's were in Romania quite a hard period, so I'm not surprised that it had an effect on demographics. The poverty continued to get worse in the early 90's, even though there were immediate improvements in alimentation and medical care.

Romanian demographics should be considered in the setting of its special and more severe brand of communism that we endured ( and force upon ourselves from a point on). The Chinese experience is somewhat different as the Communists there did not get to uproot its huge rural populations until late. That probably explains why the rural population continued to grow until the 80's. And when they started they did it in a more sensible way.

"Should that not happen likely they would not have gotten married and I would not have existed to tell their story."

Well I'm sure glad they did then. Basically thank you for the informative insight and background. Really I don't have much to add. I am sure you paint quite an accurate picture.

"Romanian demographics should be considered in the setting of its special and more severe brand of communism that we endured ( and force upon ourselves from a point on). "

I am sure you are right here, and I am sure you have a point about the massive uprooting of the rural population. There is a huge story still to be told here. I do wish someone would write a book on it or something.

"Romania was a unique case in the area."

Yep. From what I have seen I am inclined to agree. While we can see certain similarities across the EU 10, what I am also struck by are the differences between one country and the next.